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Working with Trauma and Substance Abuse—Part I* By Jeannie Little, LCSW
Staff get rejuvenated
at the recent staff
retreat at Milestones
Ranch in Malibu.
Inside this issue:
Trauma and Sub-
stance Abuse, con-2
Letter from Execu-
tive Director 3
Fundraiser, contin-
ued 3
Update on Drum-
ming Group 3
Harm Reduction In
the News 3
Looking Forward 4
Thank you to Do-
nors; New Turk
Street Office
in-
sert
Fundraiser at the Dovre Club a big Success!
On Wednesday, August 3 HRTC held a
fun-filled event at the Dovre Club in San Fran-
cisco. Thanks to
owner Elvis McEl-
hatton, who do-
nated 25% of the
proceeds from the
club that evening,
and to board mem-
ber Cynthia Hoff-
man, we had a
packed house, a
raucous shut-up karaoke session, and a couple
of very competitive raffles.
For those who don’t know what Shut Up
Karaoke is, it works like this: You pay to sing,
other people pay to shut you up, and then you
or others pay for you to sing again! When was
the last time you got to raise money by singing
badly? Staff therapist Justin Castello provided
$1/minute chair massage. And Rich Lingbaoan
of ReEnergize Bodywork donated 10 massages
for our raffle. Board and staff all pitched in to
create an amazing group effort.
HARM REDUCTION
THERAPY CENTER
Summer/Fall 2011 Volume 6, issue 1
HARM REDUCTION
THERAPY CENTER
Harm reduction therapy, especially in the community drop-in centers where we work with the majority of our clients, de-mands more from our therapists than any therapist ever imagined. We work with the most complicated people in the United States, in some of the roughest environ-ments. Our clients are poverty-stricken, homeless, and suffer from mental illnesses, social ostracism, and severe medical prob-lems. The therapists dedicated to working with these painful problems go to work every day armed with the belief that even the most hopeless people can change, full of compassion, and determined to work with people who have been relegated to shelters, food lines, and emergency rooms. The most common characteristic of the people we work with (besides drug use and abuse) is that most have been abused or neglected as children or have been subjected to horrific life experiences as adults. And they live extremely stressful and dangerous lives today. Most Americans will experience a
traumatic event at some point in our lives, according to Brian Bride, a writer and re-searcher in the field of trauma, and 8% de-velop post-traumatic stress disorder (PTSD). For people in mental health treatment pro-grams, almost 95% have experienced trauma and 31 to 42% have symptoms of PTSD. Reviewing studies of people who abuse drugs and alcohol, Jennifer Plummer, an HRTC therapist, found that teenagers who were abused as children are up to 12 times more likely to have a problem with drugs than those who were not. If they were sexually abused, teenagers are 18-21 times more likely to develop a drug problem. Somewhere be-tween 56% (men) and 90% (women) of adults who abuse drugs and/or alcohol had child-hood experiences of abuse. At HRTC, 100% of our community clients have traumatic histories, and they con-front danger every day. Especially in the Ten-derloin, life is a war zone.
*This is the first of a 3-part series about HRTC’s work with trauma and substance abuse.
Continued on page 2
What is trauma?
Trauma refers to any experience that 1) is beyond the realm of normal and expected human experience; 2) involves actual or threatened death or injury, either to oneself or close oth-ers or witnessed ; 3) causes fear or horror and intense physical or emotional distress; and 4) overwhelms one’s ability to cope, even for a short time. Traumatic events include natu-ral disasters such as earthquakes, fires, or famine; community or national events like war, geno-cide, or immigration; family circumstances such as hunger and poverty, domestic violence, child abuse or neglect, or death of a parent, sibling or child; and personal experiences such as rape, imprisonment, accident or medical illness. Some peo-ple heal from such experi-ences. Others manage to get through life without major disruption to their ability to work, love, and laugh. Unfor-tunately, a third group devel-ops symptoms of post-traumatic stress.
What is post-traumatic stress disorder (PTSD)?
PTSD is a complex neurobio-logical and psychological re-sponse to trauma that emerges after the experience is over. Symptoms include:
Re-experiencing—intrusive thoughts, flashbacks, or nightmares
Avoiding— people, places or things associated with the trauma, or emotional numbness - loss of interest
and detachment
Hyperarousal— hyper-vigilance, anxiety, anger, difficulty falling asleep, or exaggerated startle response
Psychological distress— depression, guilt and shame; loss of meaning, loss of faith, cynicism; damage to one’s identity and self-esteem
Re-enactment— court-ing danger in high-risk sports or hobbies, or repeatedly getting into violent relationships, either as a victim or as a perpretrator.
Why does PTSD develop
in some people exposed to trauma and not others?
The younger a person when the trauma occurs, the more likely it is that PTSD will develop. Prolonged or re-peated trauma also predicts PTSD. Two scholars** in the field of PTSD often re-fer to it as a “disorder of repair”. After a traumatic event, we need to VENT, we need to be SOOTHED
by comforting words and
gestures, and we need to be PROTECTED from further harm. These “interventions” help us to discharge the ten-sion aroused during a trauma, then to bring our neurobiological responses back to normal. If we do not have these opportunities to recover, then our crisis state starts to create perma-nent changes to our brain chemistry and our psychol-ogy. This is when we are at high risk for developing PTSD.
What is the relationship between trauma and
substance abuse?
Most of our readers know that the first principle of harm reduction therapy is people use drugs for reasons. We subscribe to the self-medication hypothesis of drug abuse. Alcohol can be, as one client said, “like a warm blanket that I wrap myself in every night.” Pot does a great job of dulling memory, and is relaxing for most folks. Heroin and other opiates are very sooth-ing drugs. Or, if alertness is important to survival, then stimulants enhance one’s attention and vigilance. By starting with this premise, HRTC therapists are able to join with our drug-using clients and begin the work of healing trauma.
Part II of the series will present how we work with trauma. Part III will address how this work affects the therapist.
**Bessel van der Kolk and Daniel Siegel.
Trauma and Substance Abuse, continued
Page 2
EXECUTIVE DIRECTOR
Jeannie Little, LCSW
CLINICAL DIRECTOR
Patt Denning, PhD
BOARD OF DIRECTORS
Officers
Kevin McGirr President
Emalie Huriaux Secretary
Cynthia Hoffman Treasurer
Directors
Lisa Blakely
Patt Denning
Jeannie Little
Shannon Riley
STAFF
Clinical Supervisor
Perri Franskoviak, PhD
Program Coordinators
Jen Plummer, PhD
Jamie Lavender, MFT
Staff Therapists
Simbwala Schultz, MFTI Celia Sampayo Perez,
ASW
Vilma Argueta, MFTI
Mariko Obrero, ASW
Intern Therapists
Justin Castello, MA
Jennifer Fernandez, MA
Tara Kline, MA
Medical Staff
Corinna Gamez, MD Psychiatrist
Carey Martin, NP, PhD Psychiatric Nurse Practitioner
Anne Barnes, MD Medical Director
(Medical Director Barry Zevin, MD, is
on sabbatical)
Administrative Staff
Emily Lavender Administrative Manager
Chris Ruiz Training Assistant
Amanda Zarkovacski Bookkeeper
Drug Users Union Staff
Lydia Blumberg
Isaac Jackson
Gary West
In a review of HRTC’s
community clients, we
found that almost 100%
had histories of serious
trauma and all live in
dangerous or highly
stressful situations now.
Welcome! In this first letter to
you, I would like to share my
appreciation for HRTC’s staff,
who work in the most difficult
environments with people long
considered to be “untreatable”.
Our front-page story tells you
some of what staff faces each day
they go to work.
I can honestly say that
HRTC’s therapists are the most
skilled I have ever met, or could
ever imagine. They grow in
popularity among clients, and in
reputation around the Bay Area
and the country, every year. At
the Homeless Youth Alliance,
where young homeless partici-
pants are notoriously averse to,
and traumatized by, mental health
institutions, our rating in the
agency’s recent client satisfaction
survey topped 95%.
At our community pro-
grams, cries of “Jamie” “Jen”
“Celia” “Mariko” “Justin” “Jenn”
“Vilma” “Dr. Zevin” “Carey”
ring out every time they walk
through the drop-in centers. Our
10 weekly drop-in groups are full
to bursting, often with standing
room only. Our 7 community
therapists and two community
medical staff work with 800+
homeless clients per year, often in
crisis, sometimes daily, always
with compassion. How?
They believe —that the
most chaotic of drug users can
benefit from
therapy if it is
accessible;
that, given
options rather
than man-
dates for
change, peo-
ple will move
toward health. And we continue
to offer staff a rich program of
supervision, support and training.
Not only is it challeng-
ing to sustain daily support for
100’s of people with devastated
lives, but the therapy we provide
is unparalleled in its skill. Never
has such a socially marginalized
group of people received such
high quality and loving care.
Jamie Lavender,
LMFT, and I, both HRTC thera-
pists and drummers, facilitate
our drumming group. Drum-
ming is an ancient practice and
rhythm is our natural birth
force. The group has estab-
lished a regular membership
and has many newcomers who
testify about the benefits of playing together. Some have
said they experience an in-
crease of energy, motivation,
and connectedness, less de-
pression and anxiety, better
It has been over six
months since we started our
first drumming group back in
December of 2010. Thanks to
collaboration between HRTC
and Central City Hospitality
House, our dream came true.
We now have for the commu-
nity of the Tenderloin an estab-
lished drumming healing group funded by the CA Mental
Health Services Act Holistic
Wellness program: Healing,
Organizing, and Leadership
Development.
sleep, increase of alertness, con-
centration and self-control. Oth-
ers have said that they feel calm,
focused and grounded every time
they play drums. Our partici-
pants are very diverse , and in-
clude many women (in a male-
dominated center), older adults,
and even a 2-1/2 year old child
accompanied by his dad. The healing intention of our journey
of playing drums is to create com-
munity. It is all about playing,
having fun, and healing together.
Letter from the Executive Director Jeannie Little, LCSW
It’s All About Playing And Healing Together by Celia Sampayo Perez, ASW
FUNDRAISER, continued
The night was one of
our best fundraisers so far and
we hope to have more such fun
nights in the future.
Raising money for HRTC and having a great time — what could be better?
Justin giving a chair
massage! Friend Lila Louie also
volunteered to lend a hand.
Is moderation a reasonable treatment goal?
As with everything in harm reduction, it depends on
many factors, but “research suggests there
is no added harm in
patients trying moderation as opposed to abstinence.
In fact, offering options increases optimism, so the
balance of clinical advantage lies in widening
treatment access by permitting choice” Initial preference for drinking goal in the
treatment of alcohol problems: II. Treatment
outcomes.
Adamson S.J., Heather N., Morton V. et al.
Alcohol and Alcoholism: 2010, 45(2), p.
136–142.
Page 3 Volume 6, issue 1
“Faced with rising drug overdose deaths, New York is the latest -- and largest -- state to pass a 911 Good Samaritan law allowing people to seek help without fear of prosecution. New York Gov. An-drew Cuomo signed into law on July 20 legislation aimed at reduc-ing the number of preventable drug overdose deaths in the Empire State. The new law gives protection from prosecution for drug posses-sion offenses to overdose victims seeking medical help or to people seeking medical help for them.” —Philip Smith, 7/22/11. See the whole article on: Stop the Drug War.com
Attend the 2011 International Conference
on Drug Policy Reform Los Angeles, California
November 2-5 www.drugpolicy.org/
HARM REDUCTION
IN THE NEWS
45 Franklin Street, Suite 320
San Francisco, CA 94102
415-863-4282 fax: 510-251-1139
The Harm Reduction Therapy
Center has a mission to practice and promote a model of integrated mental health and
substance abuse treatment that welcomes under-served
substance users with serious
emotional problems. The treatment, harm reduction psychotherapy, is based on the importance of “Any Positive
Change”. Harm Reduction Therapy does not require abstinence as either a condition
of, or a goal of, treatment. HRTC’s highest value is client choice — we put the reduction
of harm before any other ideals.
Upcoming events and news—
Harm
Reduction
Therapy
Center
Harm
Reduction
Therapy
Center Would you like to re-ceive future newsletters via email instead of on paper? Help us save trees and money by signing up for our mail-ing list! Send an email to hrtctherapy @yahoo.com asking to remove you from the “paper” list and we will put you on the “paper-less” list. Thank you! Like us on FACEBOOK!
www.harmreductiontherapy.org
LOOKING FORWARD
A major revision of Practicing Harm Reduction Psycho-
therapy is due out in October. It is rich with 10 more
years of practice and research; it includes new chapters
on trauma, community treatment, group treatment,
family treatment, and ethics.
Karaoke fun at HRTC’s recent event at
the Dovre Club in San Francisco.
Check out our new website—
it’s much easier to navigate!
www,harmreductiontherapy.org
We have moved our offices
in San Francisco. We now
have our own center!! Note our new address in the
sidebar to left.
Stay tuned in early Septem-
ber for the SF Drug Users
Union in the New York
Times
Save the Date! Friday evening , November 18th
Come celebrate HRTC’s 11th anniversary and the publication of the 2nd edition of Practicing Harm Reduction Psychotherapy. Hear powerful guest speaker, neuroscience journalist Maia Szalavitz, whose amazing writings on addiction can be found at http://time.healthland.com/author/maiasz. Check our website, and our Facebook page for more details!
www.harmreductiontherapy.org
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